Provider Demographics
NPI:1518027606
Name:UNIVERSAL HEALTH GROUP, INC
Entity type:Organization
Organization Name:UNIVERSAL HEALTH GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:ZACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-626-6892
Mailing Address - Street 1:5761 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2270
Mailing Address - Country:US
Mailing Address - Phone:248-626-6892
Mailing Address - Fax:248-855-2477
Practice Address - Street 1:5761 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2270
Practice Address - Country:US
Practice Address - Phone:248-626-6892
Practice Address - Fax:248-855-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064477208100000X
MI5101010930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P48640Medicare PIN